AB0220 FACTORS ASSOCIATED WITH CAROTID INTIMA MEDIA THICKNESS REDUCTION IN RHEUMATOID ARTHRITIS PATIENTS: A FOLLOW-UP STUDY
Authors: N. Guajardo-Jauregui, D. Á. Galarza-Delgado, J. R. Azpiri-López, I. J. Colunga-Pedraza, A. Cárdenas, A. N. Garza-Cisneros, A. Garcia-Heredia, M. A. Balderas-Palacios, A. B. Rodriguez-Romero
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) patients have higher risk of developing cardiovascular (CV) events than the general population. Traditional CV risk algorithms have been shown to underestimate the real CV risk of RA patients (1). For this reason, current CV risk guidelines state that a carotid ultrasound could be considered as part of the CV evaluation of these patients. Objectives To describe the carotid ultrasound changes in the follow-up of RA patients, and to compare demographic and disease characteristics in patients who had a reduction of carotid intima media thickness (cIMT) and those who did not. Methods Longitudinal, observational, and prospective study. A total of 39 RA patients were included in this study. A first evaluation, including a carotid ultrasound, laboratory analyses, and clinical history, was performed at the time of inclusion. Posteriorly a follow-up carotid ultrasound was performed. Patients were divided into two groups, those with reduction of cIMT in both carotid arteries, and those who remained with the same measurements or had an increase of cIMT. Comparisons were done with Chi-square test or Fisher’s exact test for qualitative variables and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p -value &lt; 0.05 was considered statistically significant. Results Median follow-up was 4.66 (4.33-5.00) years. When evaluating changes in the carotid ultrasound findings, 15 (38.5%) patients developed CP, 8 (20.5%) patients developed bilateral CP, and 10 (25.6%) patients had a reduction of cIMT at the follow-up (Figure 1). When comparing baseline characteristics, we found that patients with reduction of cIMT were younger (48.88 years vs 59.30 years, p = 0.004), with a lower prevalence of dyslipidemia (0% vs 34.5%, p = 0.040), had lower levels of erythrocyte sedimentation rate (ESR) (14.50 mm/h vs 28.0 mm/h, p = 0.024), and had higher prevalence of normal levels of ESR (&lt;20 mm/h) (80.0% vs 27.6%, p = 0.007) than patients who remained with the same measurements or had an increase of cIMT (Table 1). A multivariate analysis was performed, including variables with a p -value &lt; 0.05, and we found that normal ESR was an independent factor associated with reduction of cIMT, with an OR 8.63 (1.27-58.33), p = 0.027. Table 1. Baseline characteristics of patients with and without reduction of cIMT. Baseline characteristics Patients with cIMT reduction (n=10) Patients without cIMT reduction (n=29) p-value Demographic characteristics Age, years, mean ± SD 48.88 ± 8.59 59.30 ± 9.46 0.004 T2DM, n (%) 0 (0) 3 (10.3) NS Hypertension, n (%) 1 (10) 11 (37.9) NS Dyslipidemia, n (%) 0 (0) 10 (34.5) 0.040 Active smoking, n (%) 0 (0) 2 (6.9) NS Obesity, n (%) 6 (60) 8 (27.6) NS Treatment Statins, n (%) 2 (20) 7 (24.1) NS MTX, n (%) 9 (90) 23 (79.3) NS GC, n (%) 6 (60) 16 (55.2) NS Disease characteristics ESR, mm/h, median (IQR) 14.50 (9.00-21.25) 28.0 (17.0-42.0) 0.024 ESR &lt;20 mm/h, n (%) 7 (70) 8 (27.6) 0.027 CRP, mg/dl, median (IQR) 0.75 (0.45-1.26) 0.91 (0.66-1.26) NS DAS28-ESR, mean ± SD 4.30 ± 1.04 4.66 ± 1.09 NS DAS28-CRP, mean ± SD 3.23 ± 0.90 3.49 ± 1.06 NS cIMT, carotid intima media thickness; T2DM, type 2 diabetes mellitus; MTX, methotrexate; GC, glucocorticoids; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; DAS28, disease activity score 28 joints. Conclusion Our results show that patients without dyslipidemia and with lower ESR levels, a proinflammatory biomarker, had a reduction in cIMT, which decreases the risk of developing a major CV event. Emphasis should be placed on tight control of disease activity and traditional CV risk factors. A follow-up carotid ultrasound evaluation in RA patients may be necessary, to identify those who would benefit from an opportune treatment. References [1]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, et al. Comparison of statin eligibility according to the Adult Treatment Panel III, ACC/AHA blood cholesterol guideline, and presence of carotid plaque by ultrasound in Mexican mestizo patients with rheumatoid arthritis. Clin Rheumatol 2016;35(11):2823-7. Disclosure of Interests None declared